Ad Hoc Endorsement Request Form

In order to help our Secretary for Prison Chaplaincy, Bob Wilson, progress your requirement for Faith Endorsement, please fill in the following form and he will be able to progress your request as soon as possible.

Name *

Name

First Name

Last Name

Prison you'll be working at:

Employment Basis

Approx. Number of Weekly Hours

National Insurance Number

Date of Birth

Date of Birth

MM

DD

YYYY

Mobile Number

Email Address

Denomination/Church Group

Referee's Name

See note below

Referee's Email Address

Other Information

Thank you for filling out the request form. Bob Wilson will get back to you as soon as possible.

[note ref Referee - should be your Senior Pastor if Volunteer Chaplain, or someone in National or Regional Oversight of Prison Chaplaincy if a paid role eg. District Chair / Regional Minister]